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General NPI Number Information
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NPI Number | 1356452114
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Entity Type | Individual
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Provider Name | FREDDY SOEWIN AW M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10300 COMPTON AVE
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City | LOS ANGELES
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State | CA
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Zip | 90002-3628
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Country | US
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Telephone | 323-564-4331
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Fax | 323-564-0560
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Provider Business Mailing Address
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Address Line | PO BOX 90422
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City | CITY OF INDUSTRY
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State | CA
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Zip | 91715-0422
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Country | US
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Telephone | 626-664-7595
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A42328
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License Number State | CA
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